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LESBIAN & BISEXUAL WOMEN’S HEALTH

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Juno Obedin-Maliver, MD, MPH, MAS & Patricia A. Robertson, MD

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Lesbian and bisexual women are considered a medically underserved population in the United States by the Institute of Medicine and since 2016, as a sexual minority group, considered a health disparity population by the US National Institutes of Health. Professional medical organizations, such as the American College of Physicians, have published position papers to educate and make recommendations on achieving equity for lesbian, gay, bisexual, and transgender (LGBT) individuals in the health care system. Barriers to care include both personal and structural. Personal barriers may include the patient’s experience of disrespectful behavior and discrimination by health care providers and staff members and feeling threatened or experiencing a refusal of treatment due to sexual orientation, which may cause delay or avoidance of care. Structural barriers may include social stigma, financial challenges caused by decreased prevalence of insurance coverage (eg, many employers do not provide same-sex partner benefits), and the lack of trained providers to care for lesbian and bisexual women. Even when lesbian and bisexual women do seek medical care, it may not be appropriately targeted to the unique issues of this underserved population and therefore less effective. A 2012 study in the United States of medical expenditure data found that women in same-sex couples were less likely to get nonurgent medical care when needed, see a specialist, and feel that doctors spent enough time with them. A study in Israel revealed that access problems also exist there; lesbian and bisexual women utilized health care less frequently than heterosexual women, resulting in unmet medical needs. The World Health Organization (WHO) recognizes the lack of medical knowledge in the care for and understanding of lesbian and bisexual women. In a 2011 report, WHO states that the limitation in available data “points to the fact that LGBT people often experience poorer health outcomes than the general population and face barriers to health care that profoundly affect their overall health and well-being.”

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